Prevention and wellness in the older adult Prevention and Wellness In The Older Adult: Prevention and wellness are essential areas that should be focused on when evaluating and treating older adults. Early detections of risk factors could make a significant difference in an older adults quality of life.
Objectives:
1.Learn what are prevention strategies and why it is vital in older adults. 2.Learn about what screening tools are valid. 3.Learn what you should do if an older adult is at increased risk. 4.Learn about environmental factors, how they can be assessed to decrease risk of injuries and why they are important.
Information about Prevention and Wellness In The Older Adult:
Learn why prevention and wellness is vital in older adults. oAs people age they become more susceptible to disease and have increased risk for injuries due to decrease in activity and weakened immune system. Early detection is used to help an older adult maintain an independent functional life. Most of the contractible diseases and health risks can be prevented through lifestyle changes and early prevention. There are three types of prevention that can be utilized with an aging individual. The first is a Primary Prevention, which is identifying risk factors and intervening before the individual develops a problem. Next, is the Secondary Prevention, which is when the individual has a disease or issue that is detected early enough you can control the severity. You are basically preventing further decline and reversing current impairment. Finally, the Tertiary Prevention, which is when the patient has functional impairment from the pathology and you try to prevent further decline. These are typically where you see your chronic diseases. Often times older adults die due to causes that could have been prevented through early detection. For example, roughly 50% of older adults who fall and fracture their hip at the age of 65 or older die within 6 months to a year (Corona et al).
Learn about what screening tools are valid. oThere are numerous screening tools out there used to better predict at risk older adults. Older adults should be screened in a number of areas such as gait speed, fall risk, balance, cardiovascular endurance, frailty, immobility/functional decline, dementia, depression, sensory issues and chronic disease. Below is a list of common areas of concerns within the older community along with valid tests/screens that can be performed for early detection.§Overall Risk Screen: SELF (self evaluation of life function questionnaire) §Dementia: Mini-Mental Status Exam, Clock drawing test, Mental Status Questionnaire, Dementia Rating scale §Falls risk (gait speed and balance): TUG, Tinetti & Functional Reach §Frailty: Slow gait speed, 30 second Chair Stand test, wt loss, TUG §Depression: Geriatric Depression Scale, Beck Depression Inventory §Sensory Issues: Vision and hearing (normal eye and hearing exam) §Cardiovascular: BP, serum cholesterol, blood glucose, ABI and exercise levels §Osteoporosis: Height change, postural change, pain §Diabetes: Serum Glucose, BUN, sensory testing §General health: Nutrition, alcohol use, tobacco use, medication use and exercise oThere are normative cutoffs for each one of these tests that can be found throughout the internet. It is highly recommended that the tester reviews the correct grading and scoring for each test prior to use.
What should one do if an older adult is found to be at risk? oIf you perform a special screen or test and find that the patient is at an increased risk, you should first determine if the issue falls within your scope of practice. For example, if a physical therapist finds that an older individual is at an increased risk for falls secondary to decreased gait speed, poor balance and decreased lower extremity strength then he or she should explain the findings and importance with the patient. They then could implement a plan of care to decrease the current risk and improve the patients overall function. However, if you are to discover that the patient is at risk for something outside of your scope of practice you should advise the patient to consult with the most appropriate health care provider for a more thorough evaluation.
Learn about environmental factors, and how they can be assessed to decrease risk of injuries and why they are important. oEnvironmental factors are things that are within the home or community that could affect an older adult’s function as well as risk for injuries. These factors should be closely evaluated for they have great importance in improving an older adult’s function as well as possibly detecting early signs of disease. Below is a list of environmental things you should assess.§Home safety: Rugs, room clutter, step heights, rails, bathroom/tub convenience, fall hazards, etc. §Color and lighting: Patients who have vision deficits my not be able to see surface changes within the home or community. This could also result in issues with meal preparation and other ADLs §Lettering: Difficulty reading road signs or dictions within the community or home can increase risk for injuries §Hearing Environment: Not being about to hear while driving increases the risk for accidents. Not hearing the phone or doorbell while at home. §Communication: Unable to communicate clearly with others explaining their needs or concerns could be very harmful and unsafe. §Dangerous Areas: This can include areas within the home that increases the older adults risk for falls. Also, driving a car could be a dangerous area depending on the patients cognitive state as well as overall wellbeing.
References 1.Negrete-Corona, J J (05/2015). "[Hip fracture as risk factor for mortality in patients over 65 years of age. Case-control study].". Acta ortopédica mexicana (2306-4102), 28 (6), p. 352. 2.Mignardot J-B, Deschamps T, Barrey E, et al. Gait disturbances as specific predictive markers of the first fall onset in elderly people: a two-year prospective observational study. Frontiers in Aging Neuroscience. 2014;6:22. doi:10.3389/fnagi.2014.00022. 3.Nicholas JA, Hall WJ. Screening and Preventive Services for Older Adults. The Mount Sinai journal of medicine, New York. 2011;78(4):498-508. doi:10.1002/msj.20275. 4.www.Apta.org 5.Halloran L. Health promotion and disability prevention in older adults. The Journal for Nurse Practitioners. 2013;9(8):546-547. http://search.proquest.com/docview/1644849468?accountid=41004. doi: http://dx.doi.org/10.1016/j.nurpra.2013.05.023. 6.Thomas JE, Tershakovec AM, Jones-Burton C, Sayeed RA, Foody JM. Lipid lowering for secondary prevention of cardiovascular disease in older adults. Drugs Aging. 2010;27(12):959-72. http://search.proquest.com/docview/802591080?accountid=41004. doi: http://dx.doi.org/10.2165/11539550-000000000-00000. 7.King DE, Player M. Preventing cardiovascular disease in older adults: The role of fiber. Aging Health. 2010;6(2):211-216. http://search.proquest.com/docview/221245449?accountid=41004. doi: http://dx.doi.org/10.2217/ahe.10.7.
Michael Radford
Prevention and wellness in the older adult
Prevention and Wellness In The Older Adult: Prevention and wellness are essential areas that should be focused on when evaluating and treating older adults. Early detections of risk factors could make a significant difference in an older adults quality of life.
Objectives:
1. Learn what are prevention strategies and why it is vital in older adults.
2. Learn about what screening tools are valid.
3. Learn what you should do if an older adult is at increased risk.
4. Learn about environmental factors, how they can be assessed to decrease risk of injuries and why they are important.
Information about Prevention and Wellness In The Older Adult:
Learn why prevention and wellness is vital in older adults.
o As people age they become more susceptible to disease and have increased risk for injuries due to decrease in activity and weakened immune system. Early detection is used to help an older adult maintain an independent functional life. Most of the contractible diseases and health risks can be prevented through lifestyle changes and early prevention. There are three types of prevention that can be utilized with an aging individual. The first is a Primary Prevention, which is identifying risk factors and intervening before the individual develops a problem. Next, is the Secondary Prevention, which is when the individual has a disease or issue that is detected early enough you can control the severity. You are basically preventing further decline and reversing current impairment. Finally, the Tertiary Prevention, which is when the patient has functional impairment from the pathology and you try to prevent further decline. These are typically where you see your chronic diseases. Often times older adults die due to causes that could have been prevented through early detection. For example, roughly 50% of older adults who fall and fracture their hip at the age of 65 or older die within 6 months to a year (Corona et al).
Learn about what screening tools are valid.
o There are numerous screening tools out there used to better predict at risk older adults. Older adults should be screened in a number of areas such as gait speed, fall risk, balance, cardiovascular endurance, frailty, immobility/functional decline, dementia, depression, sensory issues and chronic disease. Below is a list of common areas of concerns within the older community along with valid tests/screens that can be performed for early detection.§ Overall Risk Screen: SELF (self evaluation of life function questionnaire)
§ Dementia: Mini-Mental Status Exam, Clock drawing test, Mental Status Questionnaire, Dementia Rating scale
§ Falls risk (gait speed and balance): TUG, Tinetti & Functional Reach
§ Frailty: Slow gait speed, 30 second Chair Stand test, wt loss, TUG
§ Depression: Geriatric Depression Scale, Beck Depression Inventory
§ Sensory Issues: Vision and hearing (normal eye and hearing exam)
§ Cardiovascular: BP, serum cholesterol, blood glucose, ABI and exercise levels
§ Osteoporosis: Height change, postural change, pain
§ Diabetes: Serum Glucose, BUN, sensory testing
§ General health: Nutrition, alcohol use, tobacco use, medication use and exercise
o There are normative cutoffs for each one of these tests that can be found throughout the internet. It is highly recommended that the tester reviews the correct grading and scoring for each test prior to use.
What should one do if an older adult is found to be at risk?
o If you perform a special screen or test and find that the patient is at an increased risk, you should first determine if the issue falls within your scope of practice. For example, if a physical therapist finds that an older individual is at an increased risk for falls secondary to decreased gait speed, poor balance and decreased lower extremity strength then he or she should explain the findings and importance with the patient. They then could implement a plan of care to decrease the current risk and improve the patients overall function. However, if you are to discover that the patient is at risk for something outside of your scope of practice you should advise the patient to consult with the most appropriate health care provider for a more thorough evaluation.
Learn about environmental factors, and how they can be assessed to decrease risk of injuries and why they are important.
o Environmental factors are things that are within the home or community that could affect an older adult’s function as well as risk for injuries. These factors should be closely evaluated for they have great importance in improving an older adult’s function as well as possibly detecting early signs of disease. Below is a list of environmental things you should assess.§ Home safety: Rugs, room clutter, step heights, rails, bathroom/tub convenience, fall hazards, etc.
§ Color and lighting: Patients who have vision deficits my not be able to see surface changes within the home or community. This could also result in issues with meal preparation and other ADLs
§ Lettering: Difficulty reading road signs or dictions within the community or home can increase risk for injuries
§ Hearing Environment: Not being about to hear while driving increases the risk for accidents. Not hearing the phone or doorbell while at home.
§ Communication: Unable to communicate clearly with others explaining their needs or concerns could be very harmful and unsafe.
§ Dangerous Areas: This can include areas within the home that increases the older adults risk for falls. Also, driving a car could be a dangerous area depending on the patients cognitive state as well as overall wellbeing.
References
1. Negrete-Corona, J J (05/2015). "[Hip fracture as risk factor for mortality in patients over 65 years of age. Case-control study].". Acta ortopédica mexicana (2306-4102), 28 (6), p. 352.
2. Mignardot J-B, Deschamps T, Barrey E, et al. Gait disturbances as specific predictive markers of the first fall onset in elderly people: a two-year prospective observational study. Frontiers in Aging Neuroscience. 2014;6:22. doi:10.3389/fnagi.2014.00022.
3. Nicholas JA, Hall WJ. Screening and Preventive Services for Older Adults. The Mount Sinai journal of medicine, New York. 2011;78(4):498-508. doi:10.1002/msj.20275.
4. www.Apta.org
5. Halloran L. Health promotion and disability prevention in older adults. The Journal for Nurse Practitioners. 2013;9(8):546-547. http://search.proquest.com/docview/1644849468?accountid=41004. doi: http://dx.doi.org/10.1016/j.nurpra.2013.05.023.
6. Thomas JE, Tershakovec AM, Jones-Burton C, Sayeed RA, Foody JM. Lipid lowering for secondary prevention of cardiovascular disease in older adults. Drugs Aging. 2010;27(12):959-72. http://search.proquest.com/docview/802591080?accountid=41004. doi: http://dx.doi.org/10.2165/11539550-000000000-00000.
7. King DE, Player M. Preventing cardiovascular disease in older adults: The role of fiber. Aging Health. 2010;6(2):211-216. http://search.proquest.com/docview/221245449?accountid=41004. doi: http://dx.doi.org/10.2217/ahe.10.7.
Examination Measures
1) 30 second Sit to Stand Test (frailty): Below is a link to the description, purpose and grading scale for the 30 sec sit to stand test. http://www.rehabmeasures.org/Lists/RehabMeasures/DispForm.aspx?ID=1122&Source=http%3A%2F%2Fwww%2Erehabmeasures%2Eorg%2FLists%2FRehabMeasures%2FAdmin%2Easpx
2) Time Up and Go Test (Fall Risk): Below is a link to the description, purpose, grading and normative data for the TUG. http://www.unmc.edu/media/intmed/geriatrics/nebgec/pdf/frailelderlyjuly09/toolkits/timedupandgo_w_norms.pdf
3) ABI index (Cardiovascular Risk): Below is a helpful link that describes the ABI index as well as contraindication for administering the test. http://emedicine.medscape.com/article/1839449-overview
4) Mini Mental Status Examination (Dementia): Below is a link to a quick print out of the exam as well as interpretation of the exam. http://www.dhs.state.mn.us/main/groups/county_access/documents/pub/dhs16_159601.pdf
5) Balance Evaluation System Test (Balance): Below is a link to the purpose, description and interpretation to the BEST test. http://www.rehabmeasures.org/Lists/RehabMeasures/DispForm.aspx?ID=1040
Additional resources
1. Safe driving tips in seniors: http://www.seniorhomes.com/p/senior-citizens-on-the-road-tips-for-safe-driving/
2. Check list of health promotion and Disease Prevention in Older Adults. http://www.medscape.com/viewarticle/531942#vp_3
3. Awesome overview of health information for older adults. http://www.cdc.gov/aging/aginginfo/index.htm
4. For APTA members. Great guide. http://www.apta.org/Podcast/2009/9/22/
5. Home Safety tips video: http://www.moveforwardpt.com/PatientResources/VideoLibrary/detail.aspx?cid=57ab4dd8-5013-451e-8a90-fb01e9ef7d92
6. Informative power point on falls risk prevention. http://www.apta.org/BalanceFalls/FallsRiskReductionPresentation/